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Feng X, Xu Y, Zeng M, Qin Y, Weng Z, Sun Y, Gao Z, He L, Zhao C, Wang N, Zhang D, Wang C, Wang Y, Li L, Fang C, Dai J, Jia H, Yu B. Optical Coherence Tomography Assessment of Coronary Lesions Associated With Microvascular Dysfunction in ST-Segment Elevation Myocardial Infarction. Circ J 2023; 87:1625-1632. [PMID: 37407487 DOI: 10.1253/circj.cj-23-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Microvascular reperfusion following percutaneous coronary intervention (PCI) is associated with the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). We investigated how plaque characteristics detected by optical coherence tomography (OCT) in STEMI patients affect the status of the microcirculation during PCI.Methods and Results: This retrospective, single-center study was a post hoc analysis basedon the multicenter SALVAGE randomized control trial (NCT03581513) that enrolled 629 STEMI patients, and finally we enrolled 235 patients who underwent PCI and pre-intervention OCT. Microvascular perfusion was evaluated using the Thrombolysis in Myocardial Infarction (TIMI) myocardial perfusion frame count (TMPFC). Patients were divided into 3 groups based on the change in TMPFC from before to after PCI: improving TMPFC (n=11; 4.7%), stable TMPFC (n=182; 77.4%), and worsening TMPFC group (n=42; 17.9%). The proportion of patients with a microcirculation dysfunction before reperfusion was 11.9%, which increased significantly by (P=0.079) 8.5% to 20.4% after reperfusion. Compared with plaque characteristics in the stable and worsening TMPFC groups, the improving TMPFC group had fewer thrombi (90.7% and 90.5% vs. 89.4%, respectively; P=0.018), a lower proportion of plaque rupture (66.5% and 66.3% vs. 54.5%, respectively; P=0.029), and a lower proportion of lipid-rich plaques (89.6% and 88.1% vs. 63.6%, respectively; P=0.036). CONCLUSIONS PCI may not always achieve complete myocardial reperfusion. Thrombi, plaque rupture, and lipid-rich plaques detected by OCT can indicate microcirculation dysfunction during the reperfusion period.
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Affiliation(s)
- Xue Feng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yishuo Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ming Zeng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yuhan Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ziqian Weng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yanli Sun
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Zhanqun Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Luping He
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Ning Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Dirui Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Yini Wang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Lulu Li
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Chao Fang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Jiannan Dai
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University
- The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education
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Potential of optical frequency domain imaging for differentiation between early and advanced coronary atherosclerosis. Int J Cardiovasc Imaging 2022; 38:2791-2799. [DOI: 10.1007/s10554-022-02600-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 03/13/2022] [Indexed: 11/05/2022]
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Sibbald M, Pinilla-Echeverri N, Alameer M, Chavarria J, Dutra G, Sheth T. Using Optical Coherence Tomography to Identify Lipid and Its Impact on Interventions and Clinical Events - A Scoping Review. Circ J 2021; 85:2053-2062. [PMID: 34305071 DOI: 10.1253/circj.cj-21-0377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Optical coherence tomographic (OCT) imaging has enabled identification of lipid, with increasing interest in how it may affect coronary interventions and clinical outcomes. This review summarizes the available evidence around OCT identification of lipid and its effect on interventions, clinical events, and the natural history of coronary disease.Methods and Results:We conducted a scoping review using the Medline, HealthStar, and Embase databases for articles published between 1996 and 2021. We screened 1,194 articles and identified 51 for inclusion in this study, summarizing the key findings. The literature supports a common OCT definition of lipid as low-signal regions with diffuse borders, validated against histology and other imaging modalities with acceptable intra- and inter-rater reliability. There is evidence that OCT-identified lipid at the site of stent implantation increases the risk of edge dissection, incomplete stent apposition, in-stent tissue protrusion, decreased coronary flow after stenting, side branch occlusion, and post-procedural cardiac biomarker increases. In mostly retrospective studies, lipid indices measured at non-stented sites are associated with plaque progression and the development of recurrent ischemic events. CONCLUSIONS There is extensive literature supporting the ability of OCT to identify lipid and demonstrating a substantial impact of lipid on percutaneous coronary intervention outcomes. Future work to prospectively evaluate the effect of the characteristics of lipid-rich plaques on long-term clinical outcomes is needed.
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Affiliation(s)
| | | | | | | | | | - Tej Sheth
- Department of Medicine, McMaster University.,Population Health Research Institute, McMaster University
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Kumar J, O’Connor CT, Kumar R, Arnous SK, Kiernan TJ. Coronary no-reflow in the modern era: a review of advances in diagnostic techniques and contemporary management. Expert Rev Cardiovasc Ther 2019; 17:605-623. [DOI: 10.1080/14779072.2019.1653187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Jathinder Kumar
- Department of Cardiology University Hospital Limerick, GEMS, University of Limerick, Limerick, Ireland
| | - Cormac T O’Connor
- Department of Cardiology University Hospital Limerick, GEMS, University of Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology University Hospital Limerick, GEMS, University of Limerick, Limerick, Ireland
| | - Samer Khalil Arnous
- Department of Cardiology University Hospital Limerick, GEMS, University of Limerick, Limerick, Ireland
| | - Thomas J. Kiernan
- Department of Cardiology University Hospital Limerick, GEMS, University of Limerick, Limerick, Ireland
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Majeed K, Hartman E, Mori TA, Alcock R, Spiro J, Ligthart J, Witberg K, Hillis G, van Soest G, Schultz C. The Effect of Stent Artefact on Quantification of Plaque Features Using Optical Coherence Tomography (OCT): A Feasibility and Clinical Utility Study. Heart Lung Circ 2019; 29:874-882. [PMID: 31353214 DOI: 10.1016/j.hlc.2019.05.182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 05/15/2019] [Accepted: 05/24/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Optical coherence tomography (OCT) can detect detailed plaque features in native coronary arteries. Stent struts cause shadows that partially obscure the vessel wall, but plaque features can still be seen. We investigated the impact of stent artefact on plaque quantification and whether the plaque behind struts is associated with microvascular dysfunction. METHODS Patients retrospectively recruited from two centres, underwent OCT pre- and post-stenting on the same vessel segment. Lipid (LA) and calcium (CA) were measured as arcs. Macrophages, microchannels and cholesterol crystals were counted. Subsequently, we determined whether stented plaque features were associated with reduced Thrombolysis in Myocardial Infarction (TIMI) flow grade in consecutive patients who underwent OCT post-stenting. RESULTS In 52 patients the lipid arc was similar pre- vs post-stent: median (55º [13º-93º] vs. 40º [18º-87°]; difference 1º [-7º to 16º], p = NS). Pre- and post-stent lipid were strongly correlated (r = 0.92, p < 0.001). In a further 128 patients those with reduced (TIMI ≤ II) vs normal flow post percutaneous coronary intervention (PCI) showed more plaque behind struts: lipid (89º [50º-139º] vs 62º [29º-88°]; p < 0.001); and calcium (24º [6º-45º] vs 7° [0º-34º]; p = 0.031). Multivariate logistic regression analysis showed that abnormal TIMI flow post-stenting was associated with diabetes (Odds ratio [OR] 2.87, CI 1.01-8.19, p = 0.048), LA (OR 1.29, 95% CI 1.14-1.38, p < 0.001) and CA (OR 1.26, CI 1.07-1.40, p = 0.005). CONCLUSIONS Plaque behind the struts can be accurately quantified using OCT. Furthermore, OCT plaque features in stented segments are associated with microvascular dysfunction post PCI.
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Affiliation(s)
- Kamran Majeed
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia.
| | - Eline Hartman
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Trevor A Mori
- Medical School, University of Western Australia, Perth, WA, Australia
| | - Richard Alcock
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Jon Spiro
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Jurgen Ligthart
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Karen Witberg
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Graham Hillis
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
| | - Gijs van Soest
- Thorax Centre, Erasmus University Medical Centre, Rotterdam, The Netherlands; Optical and Biomedical Engineering Laboratory, School of Electrical Engineering, University of Western Australia, Perth, WA, Australia
| | - Carl Schultz
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia; Medical School, University of Western Australia, Perth, WA, Australia
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Lee CH, Hur SH. Optimization of Percutaneous Coronary Intervention Using Optical Coherence Tomography. Korean Circ J 2019; 49:771-793. [PMID: 31456372 PMCID: PMC6713825 DOI: 10.4070/kcj.2019.0198] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 07/03/2019] [Indexed: 01/16/2023] Open
Abstract
Compared to the luminogram obtained by angiography, intravascular modalities produce cross-sectional images of coronary arteries with a far greater spatial resolution. It is capable of accurately determining the vessel size and plaque morphology. It also eliminates some disadvantages such as contrast streaming, foreshortening, vessel overlap, and angle dependency inherent to angiography. Currently, the development of its system and the visualization of coronary arteries has shown significant advancement. Of those, optical coherence tomography (OCT) makes it possible to obtain high-resolution images of intraluminal and transmural coronary structures leading to navigation of the treatment strategy before and after stent implantations. The aim of this review is to summarize the published data on the clinical utility of OCT, focusing on the use of OCT in interventional cardiology practice to optimize percutaneous coronary intervention.
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Affiliation(s)
- Cheol Hyun Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Seung Ho Hur
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Korea.
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In vivo morphologic comparison of saphenous vein grafts and native coronary arteries following non-ST elevation myocardial infarction. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2018; 20:16-21. [PMID: 29773466 DOI: 10.1016/j.carrev.2018.04.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to assess the pathophysiological differences between saphenous vein grafts (SVG) and native coronary arteries (NCA) following presentation with non-ST elevated myocardial infarction (NSTEMI). BACKGROUND There is accelerated pathogenesis of de novo coronary disease in harvested SVG following coronary artery bypass (CABG) surgery, which contributes to both early and late graft failure, and is also causal in adverse outcomes following vein graft PCI. However in vivo assessment, with OCT imaging, comparing the differences between vein grafts and NCAs has not previously been performed. METHODS We performed a retrospective, observational, analysis in patients who underwent PCI with adjunctive OCT imaging following presentation with NSTEMI, where the infarct-related artery (IRA) was either in an SVG or NCA. RESULTS A total of 1550 OCT segments was analysed from thirty patients with a mean age of 66.3 (±9.0) years were included. The mean graft age of 13.9 (±5.6) years in the SVG group. OCT imaging showed that the SVG group had evidence of increased lipid pool burden (lipid pool quadrants, 2.1 vs 2.7; p = 0.021), with a reduced fibro-atheroma cap-thickness in the SVG group (45.0 μm vs 38.5 μm; p = 0.05) and increased burden of calcification (calcified lesion length = 0.4 mm vs 1.8 mm; p = 0.007; calcified quadrants = 0.2 vs 0.9; p = 0.001; arc of superficial calcium deposits = 11.6° vs 50.9°; p = 0.007) when compared to NCA. CONCLUSION This OCT study has demonstrated that vein grafts have a uniquely atherogenic environment which leads to the development of calcified, lipogenic, thin-capped fibro-atheroma's, which may be pivotal in the increased, acute and chronic graft failure rate, and may underpin the increased adverse outcomes following vein graft PCI.
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Correlation of Serum Uric Acid Levels with Nonculprit Plaque Instability in Patients with Acute Coronary Syndromes: A 3-Vessel Optical Coherence Tomography Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7919165. [PMID: 29568764 PMCID: PMC5820670 DOI: 10.1155/2018/7919165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 12/10/2017] [Accepted: 12/18/2017] [Indexed: 12/22/2022]
Abstract
Elevated serum uric acid (SUA) level is known to be a prognostic factor in patients with acute coronary syndrome (ACS). However, the correlation between SUA level and coronary plaque instability has not been fully evaluated. The aim of this study was to investigate the association between SUA level and plaque instability of nonculprit lesions in patients with ACS using optical coherence tomography. A total of 150 patients with ACS who underwent 3-vessel optical coherence tomography were selected. Patients were classified into 3 groups according to tertiles of SUA level. There was a trend towards a thinner fibrous cap (0.15 ± 0.06 versus 0.07 ± 0.01 versus 0.04 ± 0.01 mm2, p < 0.001) and a wider mean lipid arc (169.41 ± 33.16 versus 177.22 ± 37.76 versus 222.43 ± 47.65°, p < 0.001) with increasing SUA tertile. The plaques of the high and intermediate tertile groups had a smaller minimum lumen area than the low tertile group (6.02 ± 1.11 versus 5.38 ± 1.28 mm2, p < 0.001). In addition, thin-cap fibroatheromas, microvessels, macrophages, and cholesterol crystals were more frequent in the high tertile group than the low and intermediate groups. Multivariate analysis showed SUA level to be a predictor of plaque instability.
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Negishi Y, Ishii H, Suzuki S, Aoki T, Iwakawa N, Kojima H, Harada K, Hirayama K, Mitsuda T, Sumi T, Tanaka A, Ogawa Y, Kawaguchi K, Murohara T. The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction. Medicine (Baltimore) 2017; 96:e9297. [PMID: 29390391 PMCID: PMC5815803 DOI: 10.1097/md.0000000000009297] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The usefulness of distal protection devices is still controversial. Moreover, there is no report on thrombus evaluation by using optical coherence tomography (OCT) for determining whether to use a distal protection device. The aim of the present study was to investigate the predictor of filter no-reflow (FNR) by using OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was observed in 13 cases (52%). In the comparisons between cases with or without the FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid pool + thrombus index showed significant differences. In multivariate analysis, lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438, 95% CI 1.001 - 2.064, P < .05). The optimal cut-off value of lipid pool + thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%, specificity 75.0%). Moreover, when adding the evaluation of thrombus length to that of lipid pool length, the prediction accuracy of FNR further increased (IDI 0.14: 0.019-0.25, P = .023).The longitudinal length of the lipid pool plus thrombus was an independent predictor of FNR and the prediction accuracy improved by adding the thrombus to the lipid pool. These results might be useful for making intraoperative judgment about whether filter devices should be applied in primary PCI for STEMI.
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Affiliation(s)
- Yosuke Negishi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Susumu Suzuki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Toshijiro Aoki
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Iwakawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kojima
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuhiro Harada
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenshi Hirayama
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takayuki Mitsuda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takuya Sumi
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuhiro Ogawa
- Department of Cardiology, Komaki City Hospital, Aichi, Japan
| | | | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Zhang R, Chen S, Zhao Q, Sun M, Yu B, Hou J. Fragmented QRS complex is a prognostic marker of microvascular reperfusion and changes in LV function occur in patients with ST elevation myocardial infarction who underwent primary percutaneous coronary intervention. Exp Ther Med 2017; 13:3231-3238. [PMID: 28588675 PMCID: PMC5450773 DOI: 10.3892/etm.2017.4380] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 01/20/2017] [Indexed: 01/08/2023] Open
Abstract
The present study aimed to investigate the in-hospital and long-term prognostic value of fragmented QRS complex (fQRS) for microvascular reperfusion and changes in left ventricular (LV) function in patients with ST elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). A total of 216 patients with STEMI undergoing primary PCI were included in the current study. Patients were divided into two groups based on the presence (n=126) or absence (n=90) of fQRS following electrocardiograms (ECGs) on admission. Following primary PCI and follow up, patients were divided into four groups based on new onset, resolution, persistence and absence of fQRS. Major adverse cardiac events were defined to include cardiovascular death, arrhythmia, heart failure, reinfarction and target vessel revascularization. The percentage of patients with heart failure and microvascular reperfusion differed significantly between the fQRS(+) and fQRS(−) groups. Levels of N-terminal pro-brain natriuretic peptide (NT-proBNP), Peak creatine kinase-MB (CK-MB) and Troponin I levels were observed to be significantly higher in the fQRS(+) group compared with the fQRS(−) group. In univariate logistic regression analysis, left ventricular ejection fraction (LVEF), NT-proBNP, Troponin I, Peak CK-MB and microvascular reperfusion were found to be associated with fQRS. Multivariate analysis identified that LVEF, NT-proBNP, Troponin I and microvascular reperfusion may be independent predictors of fQRS. The presence of fQRS was demonstrated to be associated with left ventricular dysfunction at follow up assessments. The presence of fQRS was not only significantly associated with myocardial microvascular reperfusion and left ventricular function, but was also a prognostic marker in STEMI.
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Affiliation(s)
- Ruoxi Zhang
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
| | - Shuyuan Chen
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
| | - Qi Zhao
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
| | - Meng Sun
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
| | - Bo Yu
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
| | - Jingbo Hou
- Department of Cardiology, The 2nd Affiliated Hospital of Harbin Medical University, Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, Heilongjiang 150086, P.R. China
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Ishihara M. Distal Protection During Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction. J Atheroscler Thromb 2016; 23:1307-1308. [PMID: 27319746 PMCID: PMC5221491 DOI: 10.5551/jat.ed051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 05/23/2016] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masaharu Ishihara
- Division of Coronary Artery Disease, Department of Internal Medicine, Hyogo College of Medicine, Hyogo, Japan
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Prediction of the filter no-reflow phenomenon in patients with angina pectoris by using multimodality: Magnetic resonance imaging, optical coherence tomography, and serum biomarkers. J Cardiol 2016; 67:430-6. [DOI: 10.1016/j.jjcc.2015.06.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/19/2015] [Accepted: 06/29/2015] [Indexed: 11/18/2022]
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Predicting coronary no-reflow in patients with acute ST-segment elevation myocardial infarction using Bayesian approaches. Coron Artery Dis 2016; 25:582-8. [PMID: 25083839 PMCID: PMC4222349 DOI: 10.1097/mca.0000000000000135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective The no-reflow phenomenon is associated with a worse prognosis at follow-up for ST-segment elevation myocardial infarction (STEMI) patients with a primary percutaneous coronary intervention. To date, there is no effective method to predict no-reflow. The aim of this study was to establish a predictive system to evaluate the risk of no-reflow by integrating multiple types of information using Bayesian methods. Patients and methods STEMI patients undergoing primary percutaneous coronary intervention within 12 h from the symptom onset between January 2008 and May 2013 were initially screened from the registry database of Anzhen Hospital (Beijing, China). Baseline clinical data, laboratory studies, and procedural characteristics were recorded. The Bayesian Model and Ten-Factor Model were used and compared with the Single-Factor Models. A receiver operating characteristic curve was used to show the efficacy by presenting both sensitivity and specificity for different cutoff points. Results A total of 1059 consecutive STEMI patients were enrolled. Seventy-nine factors were collected to assess the confidence of the no-reflow phenomenon. The combined likelihood ratios were used to measure the reliability of the no-reflow phenomenon. The area under the curve (AUC) was 0.85 and 0.79 for the Bayesian Model and Ten-Factors Model, respectively, whereas the Single-Factor Model yielded a maximum AUC of 0.67. Conclusion The Bayesian Model showed high sensitivity and good specificity in predicting true relations between multiple factors and the no-reflow outcome.
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Influence of stent positioning on coronary blood flow after primary percutaneous coronary intervention. Int J Cardiol 2016; 203:134-5. [PMID: 26512826 DOI: 10.1016/j.ijcard.2015.10.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 11/22/2022]
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Lee SY, Shin DH, Shehata I, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Association between fractional flow reserve and coronary plaque characteristics assessed by optical coherence tomography. J Cardiol 2015; 68:342-5. [PMID: 26603326 DOI: 10.1016/j.jjcc.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/10/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The assessment of fractional flow reserve (FFR) in coronary lesions determines the strategy of percutaneous coronary intervention. However, the association between FFR and characteristics of the underlying coronary plaque has not been sufficiently investigated. METHODS A total of 110 coronary lesions in 106 patients were evaluated using both FFR and optical coherence tomography (OCT). Coronary plaques were classified into fibrous, fibrocalcific, or fibroatheroma according to OCT evaluation at the site of minimal lumen area. Plaque microstructures such as cap thickness, macrophage accumulation, intimal vasculature, or cholesterol crystals were also evaluated. RESULTS Lesions with FFR≤0.8 showed a higher frequency of fibroatheroma, macrophage accumulation, and cholesterol crystals when compared to those with FFR>0.8. The angle of lipid was wider in lesions with FFR≤0.8 (145.1±63.0° vs. 120.7±48.9°, p=0.047), and the longitudinal length was longer in those with FFR≤0.8 (4.2±2.8mm vs. 2.5±2.9mm, p=0.007). However, multiple linear regression analysis revealed that the morphological characteristics of plaques assessed by OCT were not independently associated with FFR. Minimal lumen area [coefficient, 0.035; 95% confidence interval (CI), 0.022-0.048; p<0.001] and area stenosis (coefficient, -0.003; 95% CI, -0.005 to -0.001; p=0.001) assessed by OCT significantly correlated with FFR. CONCLUSION The morphological characteristics of coronary plaque derived from OCT are not directly related to FFR.
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Affiliation(s)
- Seung-Yul Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Islam Shehata
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Misaki K, Uchiyama N, Mohri M, Hayashi Y, Ueda F, Nakada M. Prediction of carotid artery in-stent restenosis by quantitative assessment of vulnerable plaque using computed tomography. J Neuroradiol 2015; 43:18-24. [PMID: 26603106 DOI: 10.1016/j.neurad.2015.09.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 09/09/2015] [Accepted: 09/14/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND PURPOSE To assess the relationship between plaque volume evaluated by multidetector computed tomographic angiography (MDCT) and in-stent restenosis (ISR) after carotid artery stenting (CAS). MATERIALS AND METHODS From a retrospectively maintained database, data were collected for 52patients with carotid artery stenosis treated with CAS between 2007 and 2012. We defined ISR of≥50% as a peak systolic velocity≥200cm/s on echo-duplex scan. Carotid plaques were subdivided into four components according to radiodensity in Hounsfield units (HU) as follows: <0, 0-60, 60-130, and>600HU. Risk factors that influenced ISR were compared using univariate and multivariate Cox regression analyses. RESULTS During a median follow-up period of 36months, ISR of≥50% was detected in five patients (9.6%). In the univariate Cox proportional hazard regression analysis, renal insufficiency, coronary artery disease, total plaque volume, and plaque volumes with radiodensities<0 and≥600HU increased the risk for ISR (P<0.10). When the significant risk factors determined from the univariate analysis were subjected to a multivariate analysis, only the volumes of the plaque components with radiodensities<0 HU independently predicted the development of ISR (hazard ratio: 1.041; 95% confidence interval: 1.006-1.078; P=0.021). CONCLUSION Our data suggest that the high volume of the plaque components with radiodensities<0HU was independently associated with the increased risk of ISR after CAS. Quantitative and qualitative tissue characterizations of carotid plaques using MDCT might be a useful predictive tool of the development of ISR.
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Affiliation(s)
- Kouichi Misaki
- Kanazawa University, Graduate School of Medical Science, Division of Neuroscience, Department of Neurosurgery, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan.
| | - Naoyuki Uchiyama
- Kanazawa University, Graduate School of Medical Science, Division of Neuroscience, Department of Neurosurgery, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan
| | - Masanao Mohri
- Kanazawa University, Graduate School of Medical Science, Division of Neuroscience, Department of Neurosurgery, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan
| | - Yutaka Hayashi
- Kanazawa University, Graduate School of Medical Science, Division of Neuroscience, Department of Neurosurgery, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan
| | - Fumiaki Ueda
- Kanazawa University, Graduate School of Medical Science, Division of Cardiovascular Medicine, Department of Radiology, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan
| | - Mitsutoshi Nakada
- Kanazawa University, Graduate School of Medical Science, Division of Neuroscience, Department of Neurosurgery, 13-1 Takara-machi, Kanazawa, 920-8641 Ishikawa, Japan
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Kubo T, Yamano T, Liu Y, Ino Y, Shiono Y, Orii M, Taruya A, Nishiguchi T, Shimokado A, Teraguchi I, Tanimoto T, Kitabata H, Yamaguchi T, Hirata K, Tanaka A, Akasaka T. Feasibility of Optical Coronary Tomography in Quantitative Measurement of Coronary Arteries With Lipid-Rich Plaque. Circ J 2015; 79:600-6. [DOI: 10.1253/circj.cj-14-1085] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Yamano
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yong Liu
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Makoto Orii
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Akira Taruya
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | - Aiko Shimokado
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Ikuko Teraguchi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Tanimoto
- Department of Cardiovascular Medicine, Wakayama Medical University
| | | | | | - Kumiko Hirata
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Atsuhi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
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Evaluation of hemodynamically severe coronary stenosis as determined by fractional flow reserve with frequency domain optical coherence tomography measured anatomical parameters. J Cardiol 2014; 64:19-24. [DOI: 10.1016/j.jjcc.2013.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 10/09/2013] [Accepted: 11/07/2013] [Indexed: 11/22/2022]
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Konishi A, Shinke T, Otake H, Nakatani D, Nakagawa M, Inoue T, Hariki H, Osue T, Taniguchi Y, Iwasaki M, Nishio R, Hiranuma N, Kinutani H, Kuroda M, Shite J, Hirata KI. Impact of hemodialysis on local vessel healing and thrombus formation after drug-eluting stent implantation. J Cardiol 2013; 64:25-31. [PMID: 24377659 DOI: 10.1016/j.jjcc.2013.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/04/2013] [Accepted: 10/29/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although hemodialysis (HD) is a suggested risk factor for stent thrombosis, its contribution to local vessel healing after drug-eluting stent (DES) implantation is unclear. METHODS A total of 121 patients (152 lesions treated with DES) who underwent 8-month follow-up coronary angiography with optical coherence tomography (OCT) were enrolled, and the findings were compared between patients with and without HD. To match baseline differences, mid-term OCT findings of 42 propensity score-matched lesions (21 non-HD vs. 21 HD) were compared. Effects of HD on the efficacy of antiplatelet therapy were also evaluated by VerifyNow assay (Accumetrics, San Diego, CA, USA). RESULTS Patients with HD had a significantly higher rate of thrombus formation than those without (64% vs. 33%, p = 0.007), although the baseline parameters and lesion characteristics differed between the groups. Multivariate logistic regression analysis revealed that HD was associated with an increased risk of thrombus formation (odds ratio 5.991, 95% confidence interval: 1.972-18.199, p = 0.002). Even after propensity-matching for patient background and balancing of angiographic and OCT variables, the risk of thrombus formation remained significantly higher in HD patients. The P2Y12-reaction unit was significantly increased after HD (Pre HD: 211 ± 75 vs. Post HD: 262 ± 59, p = 0.01), but patients without HD showed no increase during the same elapsed time (221 ± 88 vs. 212 ± 96, p = 0.19). CONCLUSIONS HD is a potential risk factor for subclinical thrombus attachment after DES therapy. Systemic problems, such as residual platelet reactivity, associated with HD as well as local vessel features in HD patients might contribute to the increased incidence of thrombus attachment and subsequent onset of thrombotic event after DES implantation.
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Affiliation(s)
- Akihide Konishi
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Toshiro Shinke
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan.
| | - Hiromasa Otake
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Nakagawa
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Takumi Inoue
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Hirotoshi Hariki
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Tsuyoshi Osue
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Yu Taniguchi
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Masamichi Iwasaki
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Ryo Nishio
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Noritoshi Hiranuma
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Hiroto Kinutani
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Masaru Kuroda
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Junya Shite
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
| | - Ken-ichi Hirata
- Kobe University Graduate School of Medicine, Division of Cardiovascular and Respiratory Medicine, Department of Internal Medicine, Kobe, Hyogo, Japan
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De Maria GL, Patel N, Kassimis G, Banning AP. Spontaneous and procedural plaque embolisation in native coronary arteries: pathophysiology, diagnosis, and prevention. SCIENTIFICA 2013; 2013:364247. [PMID: 24455430 PMCID: PMC3881665 DOI: 10.1155/2013/364247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2013] [Accepted: 11/11/2013] [Indexed: 06/03/2023]
Abstract
The detachment of atherothrombotic material from the atherosclerotic coronary plaque and downstream embolisation is an underrecognized phenomenon and it causes different degrees of impairment of the coronary microcirculation. During treatment of obstructive atherosclerotic plaque by percutaneous coronary intervention (PCI) distal embolisation (DE) is considered to be inevitable and it is associated with potential clinical and prognostic implications. This review aims to assess the main aspects of both spontaneous and procedural DE, analyze their different pathophysiology, provide specific insights on the main diagnostic tools for their identification, and finally focus on the main strategies for their treatment and prevention.
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Affiliation(s)
- Giovanni Luigi De Maria
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK
- Cardiovascular Medicine Department, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Niket Patel
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK
| | - George Kassimis
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK
| | - Adrian P. Banning
- Oxford Heart Centre, John Radcliffe Hospital, Oxford University Hospitals, Headley Way, Oxford OX39DU, UK
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21
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Yajima J. What imaging modality do you want to select for prediction of the no-reflow phenomenon? J Cardiol 2013; 62:138-9. [DOI: 10.1016/j.jjcc.2013.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/14/2013] [Indexed: 11/25/2022]
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